Intracranial Arteriovenous Malformations

by Stieg; Philip E.

• ISBN13: 9780824709938
• ISBN10: 0824709934
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-10-25
• Publisher: CRC Press

Summary

Offering expert recommendations and selected color illustrations, this guide furnishes readers with state-of-the-art information on the pathophysiology, diagnosis, evaluation, and treatment of AVMs. Offering a multidisciplinary approach, this book spans a wide array of therapeutic options and surgical approaches with step-by-step presentations of each procedure covered in the text.

Table of Contents

Preface	iii
Contributors	xiii
SECTION I: ANATOMY AND PHYSIOLOGY
Surgical Anatomy	1	(20)
Helder Tedeschi
Evandro de Oliveira
Wen Hung Tzu
Albert L. Rhoton, Jr.
Introduction	1	(1)
Frontal Lobe AVMs	1	(1)
Parietal Lobe AVMs	2	(1)
Temporal Lobe AVMs	3	(2)
Occipital Lobe AVMs	5	(1)
Mediobasal Temporal Lobe AVMs	5	(4)
Interhemispheric Parafalcine and Callosal Region AVMs	9	(2)
Basal Ganglia Region AVMs	11	(7)
AVMs of the Posterior Fossa	18	(1)
References	19	(2)
Pathology and Genetic Factors	21	(10)
Ronald F. Moussa
John H. Wong
Issam A. Awad
Pathology	21	(4)
Genetic Factors	25	(2)
References	27	(4)
Hemodynamic Properties	31	(18)
Michael Morgan
Introduction	31	(1)
Hemodynamic Effect within the Interstices of an AVM	32	(1)
Hemodynamic Effect on Cerebral Blood Vessels in the Presence of an AVM	33	(4)
Hemodynamic Effect on the Microcirculation of the Brain Associated with an AVM	37	(1)
Autoregulation and Reactivity to Changes in PaCO2	38	(2)
Hemodynamic Effect on Cerebral Blood Vessels at the Time of AVM Ablation	40	(1)
Hemodynamic Effect on the Brain at the Time of AVM Ablation	40	(1)
Arterio-Capillary-Venous Hypertensive Syndromes	41	(1)
References	42	(7)
Use of Modeling for the Study of Cerebral Arteriovenous Malformations	49	(24)
William L. Young
Erzhen Gao
George J. Hademenos
Tarik F. Massoud
Introduction	49	(1)
Importance of Modeling for AVMs	49	(1)
Specific Modeling Attempts-Model Construction	50	(5)
Model Applications	55	(3)
Long-Term Objectives of Computational Modeling	58	(1)
Animal Modeling	59	(2)
Summary	61	(1)
Appendix 1. Description of a Computational AVM Model	61	(2)
Appendix 2. Mathematical and Computational Approach	63	(4)
Appendix 3. Vascular Stress	67	(1)
References	68	(5)
SECTION II: CLINICAL PRESENTATION AND DIAGNOSTIC EVALUATION
Natural History	73	(8)
Bernard R. Bendok
Christopher Eddleman
Joseph G. Adel
M. Jafer Ali
H. Hunt Batjer
Stephen L. Ondra
Introduction	73	(1)
Presenting Symptoms	73	(2)
Morbidity and Mortality Related to Hemorrhage	75	(2)
AVMs in the Gravid Woman	77	(1)
Anatomical Factors Influencing the Natural History of AVMs	77	(1)
Spontaneous Regression	78	(1)
References	79	(2)
Classification and Grading Systems	81	(14)
Kai U. Frerichs
Philip E. Stieg
Robert M. Friedlander
Introduction	81	(1)
Classification and Grading Parameters	81	(3)
Grading Scales	84	(7)
Discussion	91	(1)
References	92	(3)
Radiographic Diagnosis	95	(20)
R. Anthony Murray
Eric J. Russell
Introduction	95	(1)
Epidemiology and Natural History	95	(1)
Therapeutic Options and Classification	96	(1)
Computed Tomography	97	(1)
Magnetic Resonance Imaging and Angiography	98	(7)
Conventional Angiography	105	(4)
Angiographically Occult AVMs	109	(1)
Conclusion	109	(1)
References	110	(5)
Functional Evaluation and Diagnosis	115	(8)
Shervin R. Dashti
Jeffrey L. Sunshine
Robert W. Tarr
Warren R. Selman
Introduction	115	(1)
Parenchymal Function	115	(3)
Relative Perfusion	118	(1)
Blood Pressure and Flow Analysis	119	(1)
Invasive Provocation	120	(1)
Conclusion	120	(1)
References	120	(3)
SECTION III: BASIC CONSIDERATIONS
Decision Analysis for Asymptomatic Lesions	123	(12)
James McInerney
Robert E. Harbaugh
Introduction	123	(1)
Decision Analysis and Markov Modeling for the Treatment of Asymptomatic AVMs	124	(3)
Data Collection	127	(3)
Sensitivity Analysis	130	(2)
Conclusion	132	(3)
References	133	(2)
Multimodality Therapy: Treatment Algorithms	135	(10)
Philip E. Stieg
Vallabh Janardhan
Howard A. Riina
Introduction	135	(1)
Pathology of the AVM	135	(1)
Location of the AVM	136	(1)
Natural History	136	(1)
Patient Characteristics	137	(1)
Diagnostic Imaging	137	(1)
Management Options	138	(2)
Decision Analysis for the Management of Unruptured AVMs	140	(1)
Decision Analysis for the Management of Ruptured AVMs	140	(1)
Conclusions	141	(1)
References	141	(4)
Surgical Principles	145	(14)
Christopher C. Getch
Christopher Eddleman
Melanie K. Swope
H. Hunt Batjer
Introduction	145	(1)
Preoperative Imaging	145	(4)
Embolization	149	(1)
Anesthesia	149	(2)
Neurosurgical Emergency: Intracranial Hemorrhage Related to AVM Rupture	151	(1)
Surgical Resection	152	(5)
Conclusion	157	(1)
References	157	(2)
Endovascular Principles	159	(18)
Charles J. Prestigiacomo
John Pile-Spellman
Introduction	159	(1)
Historical Perspective	159	(1)
Role of Endovascular Therapy	160	(5)
Hemodynamic Considerations and Staging of Embolization	165	(1)
Anesthetic Considerations and Monitoring	166	(1)
Functional Testing	167	(1)
Equipment	168	(3)
Strategy and Technique	171	(1)
Outcomes	172	(1)
Complications and Complication Avoidance	172	(2)
Future Directions	174	(1)
References	174	(3)
Radiosurgical Principles	177	(12)
Susan C. Pannullo
Jordan Abbott
Robert Allbright
Introduction	177	(1)
History of Radiosurgery for AVMs	177	(1)
Radiobiology of AVM Radiosurgery	177	(1)
Pathologic Changes of AVMs After Radiosurgery	178	(1)
Radiosurgery Platforms	178	(1)
Stereotactic Radiosurgery Technique	178	(4)
Evaluation of Treatment Response	182	(1)
Complications	183	(1)
Combined Modality Management of AVMs	183	(1)
Single Fraction Versus Fractionated Therapy	183	(1)
Future Directions for AVM Radiosurgery	184	(1)
References	184	(5)
Combined Therapy: The Team Approach	189	(12)
C. Michael Cawley, III
Harry J. Cloft
Nelson M. Oyesiku
Daniel L. Barrow
Introduction	189	(1)
Goals of Therapy	189	(1)
Therapeutic Strategies	190	(6)
Remedies for Palliation	196	(2)
Conclusion	198	(1)
References	198	(3)
SECTION IV: THERAPEUTIC MANAGEMENT
Anesthetic Considerations	201	(14)
Tomoki Hashimoto
William L. Young
General Considerations	201	(1)
Cerebral Circulatory Changes in Patients with AVMs	202	(1)
Anesthetic Management During Surgery	203	(3)
Anesthetic Management During Interventional Neuroradiologic Procedures	206	(5)
References	211	(4)
Supratentorial Lobar Arteriovenous Malformations	215	(28)
John E. Wanebo
Jeffrey G. Ojemann
Ralph G. Dacey, Jr.
Introduction	215	(1)
General Considerations	215	(13)
Frontal Lobe AVMs	228	(3)
Temporal Lobe AVMs	231	(2)
Parietal Lobe AVMs	233	(2)
Occipital Lobe AVMs	235	(2)
References	237	(6)
Perisylvian Arteriovenous Malformations	243	(16)
Harold J. Pikus
Roberto C. Heros
Introduction	243	(1)
Presentation	244	(1)
Diagnostic Studies	244	(2)
Management	246	(8)
Results	254	(1)
References	254	(5)
Supratentorial Periventricular Arteriovenous Malformations	259	(14)
Charles J. Prestigiacomo
Robert A. Solomon
Introduction	259	(1)
Epidemiology, Presentation, and Natural History	259	(1)
Anatomical Considerations	260	(2)
Evaluation of Patients with Periventricular AVMs	262	(1)
Therapeutic Options	263	(1)
Surgical Approaches	264	(5)
Conclusions	269	(1)
References	270	(3)
Corpus Callosum Arteriovenous Malformations	273	(12)
Vallabh Janardhan
Howard A. Riina
Philip E. Stieg
Introduction	273	(1)
Epidemiology	273	(1)
Anatomy of the Corpus Callosum	274	(1)
Functions of the Corpus Callosum and Callosal Syndromes	275	(1)
Clinical Presentation	275	(2)
Classification/Grading Systems for AVMs of the Corpus Callosum	277	(1)
Treatment	278	(4)
Summary	282	(1)
References	283	(2)
Arteriovenous Malformations of the Cerebellar Vermis and Hemispheres	285	(14)
Andrew D. Fine
Curtis L. Beauregard
Arthur L. Day
Introduction	285	(1)
Cerebellar Surface Anatomy and Vascular Supply	285	(3)
Cerebellar Functional Anatomy	288	(1)
Clinical Presentation	289	(1)
Classification and Risk Stratification	289	(1)
Treatment	290	(5)
Summary	295	(1)
References	296	(3)
Infratentorial Cerebellopontine Angle Arteriovenous Malformations	299	(16)
Giuseppe Lanzino
L. Nelson Hopkins
Introduction	299	(1)
Regional Anatomy	299	(3)
Clinical Presentation	302	(1)
Diagnosis	303	(1)
Therapy	304	(1)
Surgical Technique	305	(5)
Complications	310	(1)
Summary	311	(1)
References	312	(3)
Brainstem Arteriovenous Malformations	315	(14)
Steven D. Chang
Gary K. Steinberg
Introduction	315	(1)
Natural History	315	(1)
Classification of Brainstem AVMs	315	(1)
Arterial Supply and Venous Drainage	316	(1)
Clinical Presentation	316	(1)
Indications and Contraindications for Surgery	316	(1)
Potential Risks	317	(1)
Preoperative Preparation	317	(1)
Anesthetic Technique	317	(2)
Surgical Approaches and Positioning	319	(4)
Closure Techniques and Postoperative Management	323	(1)
Special Perioperative Equipment/Techniques	323	(1)
Stereotactic Radiosurgery	324	(1)
Embolization	324	(2)
Clinical Outcome	326	(1)
Complications and Complication Avoidance	327	(1)
Summary	327	(1)
References	327	(2)
Intraoperative and Postoperative Angiography	329	(14)
Michael A. Lefkowitz
Fernando Vinuela
Neil Martin
Introduction	329	(1)
Intraoperative Angiography	329	(7)
Intraoperative Embolization	336	(1)
Postoperative Angiography	337	(4)
References	341	(2)
Associated Aneurysms	343	(8)
Bernard R. Bendok
Christopher C. Getch
H. Hunt Batjer
Introduction	343	(1)
Classification	343	(1)
Incidence	343	(1)
Pathophysiology	344	(1)
Natural History	344	(1)
Management	344	(4)
Conclusions	348	(1)
References	349	(2)
Arteriovenous Malformations in Pregnancy	351	(8)
Eli M. Baron
Sumon Bhattacharjee
Robert Wienecke
Christopher M. Loftus
Introduction	351	(1)
Epidemiology	351	(1)
Physiologic Changes Associated with Pregnancy	351	(1)
Radiologic Diagnosis of AVM in Pregnancy	352	(1)
Medical Management	353	(1)
Surgical Management	354	(1)
Embolization and Radiosurgical Procedures	355	(1)
Ethical Considerations	355	(1)
Conclusions	355	(1)
References	356	(3)
Diagnosis and Management of Pediatric Arteriovenous Malformations	359	(12)
Jeffrey P. Greenfield
Mark M. Souweidane
Introduction	359	(1)
Epidemiology	359	(1)
Developmental Biology of AVMs in Children	359	(1)
Natural History	360	(1)
Presentation and Evaluation of AVMs in Children	361	(2)
Considerations for Intervention	363	(1)
Timing of Intervention	363	(1)
Preoperative Embolization	364	(1)
Stereotactic Radiosurgery	365	(1)
Surgical Technique	366	(1)
Complications Avoidance	366	(1)
Outcomes	367	(1)
References	368	(3)
Management of Residual Arteriovenous Malformations	371	(12)
Daniel P. McCarthy
Stefan A. Mindea
Bernard R. Bendok
Christopher C. Getch
H. Hunt Batjer
Introduction	371	(1)
Residual Malformations after Endovascular Embolization	372	(3)
Residual Malformations after Radiosurgery	375	(3)
Residual Malformations after Microsurgical Resection	378	(2)
Conclusion	380	(1)
References	380	(3)
SECTION V: SPECIAL PROBLEMS
Critical Care Management	383	(10)
Mark R. Harrigan
B. Gregory Thompson
Introduction	383	(1)
Neurological Monitoring and Imaging	383	(1)
Perioperative Cerebral Edema	384	(2)
Cardiovascular Management	386	(1)
Pulmonary Management	387	(1)
Fluids and Electrolytes	387	(1)
Nutrition and Diabetic Management	388	(1)
Infectious Disease	389	(1)
Sedation and Analgesia	389	(1)
Glucocorticoids	390	(1)
Thrombotic Complications	390	(1)
Seizure Prophylaxis and Treatment	390	(1)
References	390	(3)
Surgical Complications	393	(14)
Sean D. Lavine
Steven L. Giannotta
Introduction	393	(1)
Preoperative Considerations	393	(2)
Intraoperative Considerations	395	(5)
Postoperative Considerations	400	(3)
Summary	403	(1)
References	403	(4)
Endovascular Therapy: Indications, Complications, and Outcome	407	(22)
Adnan H. Siddiqui
P. Roc Chen
Robert H. Rosenwasser
Introduction	407	(1)
Cerebrovascular Malformations	407	(1)
Natural History of AVMs	408	(1)
Indications for Treatment	408	(9)
Management Principles for Endovascular Treatment	417	(5)
Complications: Avoidance and Management	422	(2)
The Jefferson Hospital for Neuroscience Experience	424	(1)
Summary	424	(1)
References	424	(5)
Radiosurgical Complications	429	(22)
Alan C. Hartford
Paul Chapman
Philip E. Stieg
Christopher S. Ogilvy
Jay S. Loeffler
Historical Background	429	(1)
Risk of Hemorrhage	430	(4)
Transient Effects on Normal Brain Tissue	434	(6)
Radionecrosis and Other Long-Term Effects	440	(6)
Conclusions	446	(1)
References	447	(4)
SECTION VI: FUTURE CONSIDERATIONS
Endovascular Techniques	451	(6)
Harry J. Cloft
Jacques E. Dion
Introduction	451	(1)
Microcatheters	452	(1)
Embolic Materials	452	(2)
Reduction of Complications	454	(1)
Conclusions	455	(1)
References	455	(2)
Radiosurgery	457	(12)
Douglas Kondziolka
L. Dade Lunsford
John C. Flickinger
Introduction	457	(1)
Radiobiology of Vascular Malformation Radiosurgery	457	(1)
Indications for AVM Radiosurgery	458	(1)
Clinical Experience	458	(1)
Stereotactic Radiosurgery Technique	458	(3)
AVM Obliteration	461	(1)
Postradiosurgery Effects	461	(2)
Repeat Radiosurgery	463	(1)
Staged Volume Radiosurgery	463	(1)
Future Roles for AVM Radiosurgery	463	(2)
Summary	465	(1)
References	465	(4)
Molecular Biology of Arteriovenous Malformations	469	(14)
Michael L. DiLuna
Turker Kilic
Issam A. Awad
Murat Gunel
Introduction	469	(1)
Angiogenesis and Vasculogenesis	469	(2)
Mendelian Forms of AVMs	471	(4)
Molecular Information on Sporadic AVMs	475	(4)
Future Research	479	(1)
References	479	(4)
Surgical Approaches	483	(8)
Daniel P. McCarthy
Bernard R. Bendok
Christopher C. Getch
H. Hunt Batjer
Introduction	483	(1)
Drug Delivery Systems	483	(1)
Surgical Instrumentation	484	(2)
Anatomical, Physiological and Operatively Integrated Imaging	486	(2)
Advanced Operating Suite	488	(1)
Conclusion	489	(1)
References	489	(2)
Index	491